Mental Health Awareness Month: Borderline Personality Disorder

* name changed for patient anonymity

What it can be like to have Borderline Personality Disorder:

Borderline Personality Disorder (BPD) is a disorder that makes it very difficult to function in everyday life and personal relationships. People with Borderline Personality Disorder typically have unstable emotions and moods. They can experience intense mood swings and emotional tailspins from seemingly innocuous events. This lack of control over their emotional experience can challenge interpersonal relationships as Borderline Personality Disorder sufferers are prone to intense feelings of rage, despair, and elation that can arise as quickly as they dissipate, leaving partners and loved ones reeling. In particular, “explosive anger” is one of the criteria for BPD diagnosis.

So, What Can Living with Borderline Personality Disorder Be like:

Beth*, a former patient of Harmony Recovery Group, spoke to us about her experience with Borderline Personality Disorder. “Having BPD is horrible. You are emotionally and physically reactive in ways that others can’t fathom. It’s like you are an alien at times. The rest of the world has a manual for emotions and you just sit up in your head without any instructions, tinkering with different components, trying to figure out how to be like everyone else. And you fail and you fail and you fail. Your self image becomes distorted because you are different and you know it.

My partner does not understand my emotional experience with Borderline Personality Disorder because the emotional reactivity has the look of insincerity. To me it’s real but others see me as faking or wanting attention. So I am called immature or childish or too sensitive. Too ‘this’ or too ‘that.’ It is tiresome for others to be around but it is devastating to be the one to live with it.”

Emotional swings can also lead to impulsive or self-destructive behaviors. They can range from spending money you can’t afford, drug or alcohol abuse, or binge eating. Or in other cases, like Beth’s, self harm. “Impulses present an internal reign of terror. You feel, you react and often that reaction turns to harsh self-abuse. You hurt yourself because you know you’re the wrong one. You’re damaged. It’s all your own fault. So you punish yourself for not knowing how to cope. Maybe coping is cutting or digging your nails in your arm? Maybe coping is banging your head against the wall in the bathroom at work, but very quietly so no one thinks you just want attention. You secretly shame yourself. I have bit, slapped, pinched and cut myself over and over and over…hundreds of times in my life. Always because I couldn’t cope with feeling misunderstood or rejected or excluded.”

Fear of rejection, exclusion, and abandonment are also hallmark characteristics of BPD. Fear of being alone can be so strong that a BPD sufferer fears abandonment, even from those they have come to dislike. Hence the phrase, “I hate you, don’t leave me,” coined by psychologists Dr. Jerold Kreisman and Dr. Hal Straus. A BPD sufferer’s feelings towards those closest to them can change dramatically from one minute to the next, and they often do not even know why. Feelings can shift from extreme love and closeness (idealization) to hate and anger (devaluation), in a black-and-white pattern of thinking.

All of these factors culminate in highly unstable personal relationships, often pushing away those they love most through behaviors they struggle to control.

Further symptoms of BPD can include: feelings of emptiness, suicidal thoughts, difficulty trusting, and feelings of dissociation.

Not all BPD sufferers will experience or display all of the above symptoms. Some cases may only experience a few while others will experience many. As with many mental health disorders it varies from person to person.

Beth’s Experience with Treatment for Borderline Personality Disorder:

For most BPD sufferers, all they want is to be like everybody else. As Beth says, “all you ever want is to have some understanding of what normal must feel like.”

Finding and taking the right treatment can greatly improve quality of life for BPD patients. Treatment is possible through evidence-based approaches, particularly Dialectical Behavioral Therapy (DBT).

Addiction and Borderline Personality Disorder:

Addiction and BPD often go hand-in-hand, with two thirds of Borderline Personality Disorder patients having abused a substance at some point in their lives. The unstable emotions and self-loathing caused by the above symptoms often lead Borderline Personality Disorder sufferers to try to mask their symptoms and feelings with drugs and alcohol.

For dual diagnosis patients (Borderline Personality Disorder and Addiction), treatment is most effective when the two are treated concurrently. Treating one without the other will likely exacerbate the untreated disorder and undermine the progress made on the treated disorder.